Dr Daniel Pöpping and colleagues from Germany reviewed the impact of epidural vs systemic analgesia on postoperative pulmonary complications.
Inclusion criteria were randomized comparison of epidural vs systemic analgesia lasting 24 hours or longer postoperatively and reporting of pulmonary complications, lung function, or gas exchange.
The team identified 58 trials involving 5904 patients.
Data were combined using fixed-effect and random-effects models.
The team found that the odds of pneumonia was decreased with epidural analgesia, independent of site of surgery or catheter insertion, duration of analgesia, or regimen.
The effect was weaker in trials that used patient-controlled analgesia in controls.
The researchers found that from 1971 to 2006, the incidence of pneumonia with epidural analgesia remained about 8%.
|The incidence of pneumonia with epidural analgesia was about 8%|
|Archives of Surgery|
However, with systemic analgesia, the incidence of pneumonia decreased from 34% to 12% between 1971 and 2006.
The research team noted that consequently, relative benefit of epidural analgesia decreased also.
Epidural analgesia reduced the need for prolonged ventilation or reintubation, improved lung function and blood oxygenation, and increased the risk of hypotension, urinary retention, and pruritus.
The team observed technical failures in 7%.
Dr Pöpping’s team concluded, “Epidural analgesia protects against pneumonia following abdominal or thoracic surgery.”
“However, this beneficial effect has lessened over the last 35 years because of a decrease in the baseline risk.”